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Home My WebLink AboutRe: request for info ORONO ADMINISTRATIVE OFFIC$S INFORMATION DISCLOSIIRE REQIIEST MINNESOTA GOVERNMENT DATA PRACTICES ACT REQIIESTER NOTE: A. Request Frequency - Private Data on individuals. After you have been supplied the data and informed of its meaning, �h� data need not be disclosed to you for six months thereafter unless a dispute or action is pending or additional data on you has been collected. B. You may be required to pay actual costs in making, certifying and/or compiling the copies of information requested. Date of Request: 3!``� 5 Z , Requester Name: �� C Ne , Address: 1�� orC �rC �r� City: ��uNU Zip: S J.� �i � .�- Home Phone: �l� `�-�-3 (,�73 - 2.�J�J Q Business: Description of Information Requested: ��'�r �f�� ,� �,� �wel� . , � , � (/^f � Gr' 1P Requester' s Signature: BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY Department: ls � Z Handled By: c��,,,(� �� — Request Type: -�" In person Mail Phone Requested By: Subject of Data ��ot Subject of Data Information Requested is Classified: �Public Private Confidential Non-Publzc Protected Non-Public Request is: "� Approved Denied Approved in Part Remarks/Comments: Authorized Signature: �„C�_ Fees: x = $ No. of Pages Rate per Page Total Due ORONO ADMINISTRATIVE OFFICBS INFORMATION DISCLOSDRE REQIIEST MINNESOTA GOVERNMENT DATA PRACTICES ACT REQIIESTER NOTE: A. Request Frequency - Private Data on individuals. After you have been supplied the data and informed of its meaning, the data need not be disclosed to you for six months thereafter unless a dispute or action is pending or additional data on you has been collected. B. You may be required to pay actual costs in making, certif ying and/or compiling the copies of information requested. Date of Request: �� Requester Name: �� ((� Cit � � I �i L� �; � �.i� Address: � � ��'� �� —' - y' � �- z��: 0 �� ", � � �� Business: � � �- � �'� �� v�� Home Phone: , Description• of Information Requested: �� %1-�� Y^Y\��`s� .a ��,,"� Q (�l,i� �/\� I lY� ��(� � _ ,� �� Q�'MiJ � � Requester' s Signature: ��i ('� i �. 1�.J � BELOW INFORMATION TO BE FII.LED IN BY DEPARTMENT ONLY Department: Q �Z Handled By: c..Y�� Request Type: _ � In person Mail Phone Requested By: Subject of Data �- Not Subject of Data Information Requested is Classified: �_Public Private Confidential Non-Public Protected Non-Public Request is: Approved Denied Approved in Part Remarks/Co�aents: Authorized Signature: Fees: x — $ No. of Pages Rate per Page Total Due ORONO ADMINISTRATIVE OFFICES INFORMATION DISCLOSIIRE REQIIEST MINNESOTA GO�i�NT DATA PRACTICES ACT REQIIESTER NOTE: A. Request Frequency - Private Data on individuals. After you have been supplied the data and informed of its meaning, the data need not be disclosed to you for six months thereafter unless a dispute or action is pending or additional data on you has been collected. B. You may be required to pay actual costs in making, certifying and/or compiling the copies of information requested. Date of Request: .%�� / `�� Requester Name: ��((,�{'l� ��V�CEI� Address: �J�� P✓IC�� - City: �� t� z�P: �� - ��--�' �� Home Phone: �� {(� 7GnX Business: Description of Information Requested: ��l s� l�r�t:��,/ i Gllit/� �c��) C�1- ��C�; SGlc��'•�l�V� �Yi d� Reqnester' s Signature: �' -l 1��-C �h"' \ � BELOW INFORMATION TO BE FILLED IN BY DEPARTMF:NT ONLY Department: Qt 2 Handled By: Request Type: D� In person Mail Phone Requested By: Subject of Data �_Not Subject of Data Information Requested is Classified: � Public Private Confidential Non-Public Protected Non-Public Request is: Approved Denied Approved in Part Remarks/Co�ents: Authorized Signature: U�-� Fees: x = $ No. of Pages Rate per Page Total Due